Dr Aritra Ray
Geriatrician and General Medicine Specialist, Counties Manukau Health
Geriatrician and General Medicine Specialist, Counties Manukau Health
Dr. Aritra Ray is a Geriatrician and General Medicine Specialist working in Middlemore Hospital. After training in medicine at the University of Auckland he finished his Specialist Training in Aotearoa New Zealand in 2020. He has niche interests in teaching and research, and works part-time as a small group tutor at the University of Auckland, and in the Clinical Trials Department at Middlemore Hospital. In his spare time he meditates with Self-Realization Fellowship, helps coordinate a 6000+ member hiking group, and designs new recipes out of his kitchen garden.
Prioritization of the Sickest: A Potential Source of Undocumented Triaging of Older Outpatients: A Pilot Study
Introduction: Missed outpatient appointments are a significant cost to hospitals in New Zealand. The clinical significance of delayed or missed outpatient geriatrics appointments is however unclear. We designed a study looking at associations between timeliness of attendance at outpatient geriatrics appointments and hospitalisation and death rates over time hypothesizing a difference would exist.
Aims: To ascertain if patients referred for follow-up from outpatient geriatrics clinics attend in a timely manner, and the associations between untimely attendance and morbidity (measured by rates of hospitalisation) and mortality (measured by hospital records of death).
Methods: The study was carried out in two parts. First, rates of timely follow-up of patients at an outpatients geriatrics clinic were audited between 15th June and 7th September 2016. Second, the study specifically looked for associations between a lack of timely attendance at clinic and morbidity and mortality. Hospital records were assessed retrospectively, data obtained and stored confidentially, and calculations and statistical analyses done using paired T-tests or Chi-squared analyses.
Results: Only 17% (27 out of 159 patients) of patients put forward for time-specific follow-up were seen within requested timeframes. There were statistically significant differences in morbidity (hospital admissions over three months, p-value 0.046, T-test) and mortality (death within three years, p-value 0.001, T-test) between the two groups of patients. Patients not seen on time had better observed outcomes. Conversely, patients who had earlier follow-up times requested by their reviewing clinician (regardless of whether this was met) tended to avoid hospitalisation in the medium term (1-2 years).
Conclusions: The increased hospitalisation and death rates in patients who were actually seen within clinician-requested follow-up times in a resource constrained environment may be due to a phenomenon termed ‘prioritization of the sickest’.
Introduction: Missed outpatient appointments are a significant cost to hospitals in New Zealand. The clinical significance of delayed or missed outpatient geriatrics appointments is however unclear. We designed a study looking at associations between timeliness of attendance at outpatient geriatrics appointments and hospitalisation and death rates over time hypothesizing a difference would exist.
Aims: To ascertain if patients referred for follow-up from outpatient geriatrics clinics attend in a timely manner, and the associations between untimely attendance and morbidity (measured by rates of hospitalisation) and mortality (measured by hospital records of death).
Methods: The study was carried out in two parts. First, rates of timely follow-up of patients at an outpatients geriatrics clinic were audited between 15th June and 7th September 2016. Second, the study specifically looked for associations between a lack of timely attendance at clinic and morbidity and mortality. Hospital records were assessed retrospectively, data obtained and stored confidentially, and calculations and statistical analyses done using paired T-tests or Chi-squared analyses.
Results: Only 17% (27 out of 159 patients) of patients put forward for time-specific follow-up were seen within requested timeframes. There were statistically significant differences in morbidity (hospital admissions over three months, p-value 0.046, T-test) and mortality (death within three years, p-value 0.001, T-test) between the two groups of patients. Patients not seen on time had better observed outcomes. Conversely, patients who had earlier follow-up times requested by their reviewing clinician (regardless of whether this was met) tended to avoid hospitalisation in the medium term (1-2 years).
Conclusions: The increased hospitalisation and death rates in patients who were actually seen within clinician-requested follow-up times in a resource constrained environment may be due to a phenomenon termed ‘prioritization of the sickest’.
